Provider Demographics
NPI:1275739773
Name:WILLIAM T. CHEN MD INC.
Entity Type:Organization
Organization Name:WILLIAM T. CHEN MD INC.
Other - Org Name:BAY MEDICAL CENTER FOR COSMETIC & LASER SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TSUN
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-428-3687
Mailing Address - Street 1:2801 WATERMAN BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2987
Mailing Address - Country:US
Mailing Address - Phone:707-428-3687
Mailing Address - Fax:707-422-4327
Practice Address - Street 1:2801 WATERMAN BLVD
Practice Address - Street 2:STE 200
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2987
Practice Address - Country:US
Practice Address - Phone:707-428-3687
Practice Address - Fax:707-422-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42521207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22756ZMedicare PIN